Does Maxillomandibular Advancement Surgery Normalize the Upper Airway Dimensions?

This study compared the upper airway dimensions following maxillomandibular advancement (MMA) surgery in adults with obstructive sleep apnea (OSA) with those of normal controls. Korean adult OSA patients who underwent conventional MMA (cMMA, n=12) or modified MMA (mMMA, n=7) were included, along with a control group without OSA (n=19). Presurgical (T0) and postsurgical (T1) cone-beam computed tomography scans were used to measure airway length; nasopharyngeal, oropharyngeal, and total airway volumes (AV); and mean and minimal retropalatal and retroglossal cross-sectional areas (CSAs). In the cMMA group, both SNA and SNB increased significantly (P<0.05 and 0.01), whereas in the mMMA group, only SNB showed a significant increase (P<0.05). Both groups demonstrated significant reduction in airway length and increase in nasopharyngeal AV (all P<0.05). Total AV and mean CSA increased significantly only in the cMMA group (all P<0.05), whereas minimal retropalatal and retroglossal CSAs increased significantly in both groups (all P<0.05). At T1, the 2 surgical groups showed greater oropharyngeal AV and mean CSA than the control group (all P<0.001). Differences in airway length and nasopharyngeal AV among the 3 groups were no longer significant; however, minimal retropalatal and retroglossal CSAs in both surgical groups remained smaller than those of controls (all P<0.001). MMA produced substantial airway enlargement but incomplete normalization of minimal CSAs, supporting the concept that functional airway improvement may occur without complete dimensional equivalence to normal controls.